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Monochorionic-triamniotic triplet pregnancy after intracytoplasmic sperm injection, assisted hatching, and two-embryo transfer: first reported case following IVF.

Ghulmiyyah LM, Perloe M, Tucker MJ, Zimmermann JH, Eller DP, Sills ES - BMC Pregnancy Childbirth (2003)

Bottom Line: We also outline an obstetric management strategy designed to optimize outcomes.As demonstrated here, even when two-embryo transfer is employed after IVF the statistical probability of monozygotic multiple gestation cannot be reduced to zero.We encourage discussion of this possibility during informed consent for the advanced reproductive technologies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Georgia Reproductive Specialists LLC/Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Atlanta Medical Center; Atlanta Medical Center; Atlanta, Georgia USA. dr.sills@ivf.com

ABSTRACT
BACKGROUND: We present a case of monochorionic-triamniotic pregnancy that developed after embryo transfer following in vitro fertilization (IVF). METHODS: After controlled ovarian hyperstimulation and transvaginal retrieval of 22 metaphase II oocytes, fertilization was accomplished with intracytoplasmic sperm injection (ICSI). Assisted embryo hatching was performed, and two embryos were transferred in utero. One non-transferred blastocyst was cryopreserved. RESULTS: Fourteen days post-transfer, serum hCG level was 423 mIU/ml and subsequent transvaginal ultrasound revealed a single intrauterine gestational sac with three separate amnion compartments. Three distinct foci of cardiac motion were detected and the diagnosis was revised to monochorionic-triamniotic triplet pregnancy. Antenatal management included cerclage placement at 19 weeks gestation and hospital admission at 28 weeks gestation due to mild preeclampsia. Three viable female infants were delivered via cesarean at 30 5/7 weeks gestation. CONCLUSIONS: The incidence of triplet delivery in humans is approximately 1:6400, and such pregnancies are classified as high-risk for reasons described in this report. We also outline an obstetric management strategy designed to optimize outcomes. The roles of IVF, ICSI, assisted embryo hatching and associated laboratory culture conditions on the subsequent development of monozygotic/monochorionic pregnancy remain controversial. As demonstrated here, even when two-embryo transfer is employed after IVF the statistical probability of monozygotic multiple gestation cannot be reduced to zero. We encourage discussion of this possibility during informed consent for the advanced reproductive technologies.

No MeSH data available.


Related in: MedlinePlus

Transvaginal sonogram image of intrauterine monochorionic-triamniotic triplet pregnancy at 9 weeks' gestational age, demonstrating three separate embryos, distinct amniotic membranes (A), and unified chorion (C). The conception resulted from a two-embryo transfer following IVF+ICSI.
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Figure 1: Transvaginal sonogram image of intrauterine monochorionic-triamniotic triplet pregnancy at 9 weeks' gestational age, demonstrating three separate embryos, distinct amniotic membranes (A), and unified chorion (C). The conception resulted from a two-embryo transfer following IVF+ICSI.

Mentions: Transvaginal 4 mHz sonogram (SDU400+, Shimadzu Corp; Kyoto, Japan) performed at eight weeks' gestation demonstrated a single 28 mm intrauterine gestational sac (chorion) with three distinct fetal poles, each with discrete cardiac activity. Amniotic membrane configuration could not be immediately determined. Follow-up transvaginal ultrasound one week later refined the diagnosis as monochorionic-triamniotic triplet pregnancy (Figure 1). Total daily folic acid dose was increased to 1 mg/d, and antenatal care was co-managed with periodic perinatal consultation. The obstetrical course was uncomplicated until ~19th gestational week, when cervical funneling became evident via transvaginal sonogram. Based on this finding, the patient was admitted to hospital and a McDonald (rescue) cerclage was placed without difficulty. The post-operative course was uneventful and the patient was discharged home the next day.


Monochorionic-triamniotic triplet pregnancy after intracytoplasmic sperm injection, assisted hatching, and two-embryo transfer: first reported case following IVF.

Ghulmiyyah LM, Perloe M, Tucker MJ, Zimmermann JH, Eller DP, Sills ES - BMC Pregnancy Childbirth (2003)

Transvaginal sonogram image of intrauterine monochorionic-triamniotic triplet pregnancy at 9 weeks' gestational age, demonstrating three separate embryos, distinct amniotic membranes (A), and unified chorion (C). The conception resulted from a two-embryo transfer following IVF+ICSI.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC184457&req=5

Figure 1: Transvaginal sonogram image of intrauterine monochorionic-triamniotic triplet pregnancy at 9 weeks' gestational age, demonstrating three separate embryos, distinct amniotic membranes (A), and unified chorion (C). The conception resulted from a two-embryo transfer following IVF+ICSI.
Mentions: Transvaginal 4 mHz sonogram (SDU400+, Shimadzu Corp; Kyoto, Japan) performed at eight weeks' gestation demonstrated a single 28 mm intrauterine gestational sac (chorion) with three distinct fetal poles, each with discrete cardiac activity. Amniotic membrane configuration could not be immediately determined. Follow-up transvaginal ultrasound one week later refined the diagnosis as monochorionic-triamniotic triplet pregnancy (Figure 1). Total daily folic acid dose was increased to 1 mg/d, and antenatal care was co-managed with periodic perinatal consultation. The obstetrical course was uncomplicated until ~19th gestational week, when cervical funneling became evident via transvaginal sonogram. Based on this finding, the patient was admitted to hospital and a McDonald (rescue) cerclage was placed without difficulty. The post-operative course was uneventful and the patient was discharged home the next day.

Bottom Line: We also outline an obstetric management strategy designed to optimize outcomes.As demonstrated here, even when two-embryo transfer is employed after IVF the statistical probability of monozygotic multiple gestation cannot be reduced to zero.We encourage discussion of this possibility during informed consent for the advanced reproductive technologies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Georgia Reproductive Specialists LLC/Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Atlanta Medical Center; Atlanta Medical Center; Atlanta, Georgia USA. dr.sills@ivf.com

ABSTRACT
BACKGROUND: We present a case of monochorionic-triamniotic pregnancy that developed after embryo transfer following in vitro fertilization (IVF). METHODS: After controlled ovarian hyperstimulation and transvaginal retrieval of 22 metaphase II oocytes, fertilization was accomplished with intracytoplasmic sperm injection (ICSI). Assisted embryo hatching was performed, and two embryos were transferred in utero. One non-transferred blastocyst was cryopreserved. RESULTS: Fourteen days post-transfer, serum hCG level was 423 mIU/ml and subsequent transvaginal ultrasound revealed a single intrauterine gestational sac with three separate amnion compartments. Three distinct foci of cardiac motion were detected and the diagnosis was revised to monochorionic-triamniotic triplet pregnancy. Antenatal management included cerclage placement at 19 weeks gestation and hospital admission at 28 weeks gestation due to mild preeclampsia. Three viable female infants were delivered via cesarean at 30 5/7 weeks gestation. CONCLUSIONS: The incidence of triplet delivery in humans is approximately 1:6400, and such pregnancies are classified as high-risk for reasons described in this report. We also outline an obstetric management strategy designed to optimize outcomes. The roles of IVF, ICSI, assisted embryo hatching and associated laboratory culture conditions on the subsequent development of monozygotic/monochorionic pregnancy remain controversial. As demonstrated here, even when two-embryo transfer is employed after IVF the statistical probability of monozygotic multiple gestation cannot be reduced to zero. We encourage discussion of this possibility during informed consent for the advanced reproductive technologies.

No MeSH data available.


Related in: MedlinePlus